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Request for Connection Company Company Name: Company Address: City,State,Zip: Company URL or Peering policy URL: Administrative Contact Name (last,first): E-mail Address: Phone Number: Billing Contact Name (last,first): E-mail Address: Phone Number: Address 1: Address 2: City, State and Zip: PO Number: Peering Contact Name (last,first or handle): E-mail Address: Phone Number: NOC Contact E-mail Address: 24/7 Phone Number: Connection ASN: Connection Type: 100BaseT w/ $200 setup fee Gigabit Ethernet Multi-mode Fiber w/ $1500 setup fee Gigabit Ethernet Single-mode Fiber w/ $2000 setup fee 10 Gigabit Ethernet Single-mode Fiber w/$12000 setup fee Fully-Qualified Domain Name for your interface Check here if you will support IPv6 peering Peering Policy: Please select... Open Selective Restrictive Traffic Ratios Please select... Balanced Mostly Inbound Heavy Inbound Mostly Outbound Heavy Outbound Network Type Please select... NSP (Network Service Provider/Backbone) Content Host Cable/DSL/ISP Access Provider Enterprise Education/Research Non-Profit Traffic Levels Please select... Not Disclosed 1-100 Mbps 100-1000 Mbps 1-5 Gbps 5-10 Gbps 10-20 Gbps 50-100 Gbps 100+ Gbps Comments: You will receive an invoice from GreatAccess.com, Inc. for your setup fee. Port assignments will not be made until payment is received.